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E. AREA OF ORIGIN (Continued)
The side stand, an appendage that protruded approximately 6 ft. to 8 ft. into the restaurant area, was rectangular in
design with a single passageway on the north wall, west corner. The passageway did not have a door affixed to it. The
side stand was enclosed, with its center obstructed from public view by a large built-in pastry display case. The side
stand was simply a waitress station, supplemental to the primary kitchen facilities which were located in the extreme
northeast corner of the Deli. It was constructed of metal studs covered with wall covering and assorted wallboards.
(For details on this area, see Diagram D, Seciton VI, and related information compiled by Investigators Tom Klem of
the United States Fire Administration, and John Caloggero of the National Fire Protection Association.)

By directing their full attention tofhat area known as the side stand in the Deli, the O/Rs arrived at the following
preliminary conclusions. Additional information was revealed during the subsequent investigation (which lasted approximately nine days) in the area of origin. During the course of this investigation, numerous photographic negatives
were exposed not only by the O/Rs, but by the Las Vegas Metropolitan Police Department Criminalistics Identification Bureau and E. G. & G., Inc., of Las Vegas, Nevada.
In the side stand area, the O/Rs observed burn and char patterns which, similar to those observed in the Orleans Coffee Shop, at first were unexplained, particularly that area on the inside of the east wall midway from the floor area,
and the area under the stainless shelf on the east wall. No depth of char indicating an area of origin was observed.
Burn and char patterns appeared where unknown quantities of paper goods and other material common to a waitress
station would be located. Upon close examination by the O/Rs, this area was eliminated as the area of origin, and the
char patterns were attributed to fire burning and extending from and around the north wall of this side stand. The fuel
load under the shelf and the coverings on the walls were not sufficient to propagate the spread of fire in this area.
There were no other visible or explainable patterns that would, in effect, indicate an area of origin in this side station,
except that pattern in the northwest area of the side station. Wood panelling l/l6 in. thick, laminated plastic panelling
3/32 in. thick, vinyl wall coverings, and tile adorned the walls of the southeast section of the side stand. These thin
materials did sustain fire decomposition; however, consumption was light to moderate. Burn and char patterns did
not emanate from the southeast corner, or from under the shelf in that corner. It should be emphasized that plywood
shelving and heavier panelling in the northeast corner of the side stand (later described as the point of origin) were
observed to have sustained severe fire decomposition to the point of actually being totally consumed (vaporized) by
the progress of the fire. The fact that the 518 in. plywood in the northwest corner was totally consumed, while the l/16
in. wood veneer in the southeast corner was virtually unburned, both being approximately the same height from the
floor, unquestionably indicated a point of origin in the northwest corner of the side stand.
The O/Rs observed a distinct char pattern emanating from the metal splash pan located on the inside of the side
stand’s west partition, north corner. This partition, in conjunction with the west wall of the side stand, formed an entryway and restricted the interior view of the side stand from the guests of the restaurant (see Diagram E, Section VI).
The char pattern, approximately 18 in. in height above the pan, extended approximately 13 in. in width at its base, and
was located adjacent to that area of a shelf which sustained severe fire decomposition. The char and fire patterns indicated fire emanating from that separation wall or partition.
In the passageway to the side stand, on the west partition approximately 45 in. from floor level, the O/Rs observed
another char pattern directly in line with the pattern described above the splash pan. This pattern was also similar to
that of a partition fire; no explained fire load or other contributing factor would account for its presence. The O/Rs,
by the slightest touch of the hand, caused this wall to crumble in the fire pattern described on the west partition, leaving a gaping 12 in. x 18 in. hole through which one could easily view the interior. By observing in an easterly direction
the interior side of the east wall at the partition, the O/Rs could see a fire pattern coinciding with the two previously
explained fire patterns. All three patterns were of the same height and location of this partition. In this void or wall
opening, no electrical or mechanical heat sources were observed. By removing the eastern portion of this partition, the
O/Rs could observe the remains of the soffit which had been built to restrict the electrical and plumbing equipment
from view. This soffit was constructed of plywood and gypsum, with wood trim for decorative purposes only.



F. POINT OF ORIGIN (Continued)
In the soffit, two copper like tubes were observed; one approximately l/4 in. in diameter, the other 3/8 in. in
diameter. These tubes extended from a hole in the cupboard housing the compressor, approximately 6 in. to 12 in.
from the floor area, upward through the void between the wall and cupboard. The hole, approximately 6 in. long and
2 in. wide, led into and faced that particular space. The O/Rs observed these two copper tubes to be encased in insulation up to a point approximately 40 in. from the floor; from that point to the termination point (which was the pastry
display case), the tubing lacked insulation. This condition was not due to fire decomposition; the tubing had been installed without insulation.
As stated earlier, the copper tubing extended upward toward the ceiling. It was, in fact, angled and curved around in
the soffit space upward toward the bottom portion of the pastry display case. The l/4 in. copper tubing supplied the
liquid coolant from the condenser to the pastry display case; the 3/8 in. copper tubing was the return refrigerant. (This
refrigerant is commonly known as “Freon 12”.) There were no visible holes or punctures in either copper tubing;
however, the l/4 in. line had affixed to it a small silver colored melted globule of an unknown metal type which appeared to be aluminum or similar metal. This melted globule or bead was approximately 45 in. from floor level, in line
with the fire patterns described earlier on the partition and soffit (see Diagram F, Section VI).
The O/Rs observed a 3/4 in. flexible metallic (aluminum) raceway containing two No. 12 A.W.G. copper conductors
with an unknown type of electrical insulation. The raceway extended from that same hole described above, which
allowed the copper tubing to extend from that same hole described above, which allowed the copper tubing to extend
into the refrigeration compressor area and follow the same basic path upward toward the display case (see pastry
display case, Diagrams M and N, Section VI). It was observed that this aluminum raceway was turned into and around
the copper tubing, and actually made contact with it. It was at this same intersection that the above described melted
globule or bead was observed. The raceway then extended upward, following the general path of the copper tube into
the pastry display case.
Returning their observation to that intersection of the raceway and the copper tubing, the O/Rs noted that a section of
the raceway was missing. Also missing was one single section of copper wire. The raceway had sustained heat application or chemical change to such a degree that the missing section of the raceway had vaporized or was totally destroyed
for a length of approximately 36 in., beginning at a point about 42 in. above floor level. The missing copper wire
within the raceway had sustained decomposition to the degree of actually vaporizing or being totally destroyed for approximately 2% in. The copper wire was void of any insulating material. It should be noted that a total of two, not
three, wires were in the raceway. As with the bead observed earlier, this area was in the vicinity of the east partition of
the entry of the side stand (see Diagram G, Section VI).
As stated previously, the raceway extended into the general vicinity of the pastry display case, and the copper tube extended to the bottom area of the pastry display case. At a height of approximately 58 in., the copper tube made a right
angle through the soffit and extended in an easterly direction for 5 in.; it then extended upward into the pastry display
case. The copper tube was completely enclosed in a wood soffit constructed of plywood with gypsum wallboard on
two sides, and the entire chase was hidden from view. The shelf to which the metal splash pan was affixed was attached to the inside left soffit area (west wall of side stand), which is the probable reason why the raceway and tube chase
were installed as they were.
The raceway did not turn sharply and extend eastward, but continued upward through the wall cavity of the soffit.
Upon reaching that portion of the top plate, or ceiling area, above the pastry display case, it angled toward the center
area in the plenum above the side stand. It terminated at a metal 4 in. x 4 in. junction box (see Diagram H, Section
VI). Where the raceway turned above the pastry display case, the O/Rs observed that the flexible aluminum raceway
was not melted. No globular or beaded copper was observed in the area, although the copper wire was void of insulation. (This raceway is clearly marked “AL-Fl-11” on Diagram J, Section VI.)
Two 3/4 in. flexible aluminum raceways were observed originating from this junction box, in addition to the raceway
that entered it. One raceway extended westward, the other eastward, both in the plenum above the side stand. The first
raceway extended in the same direction (west), and was of the same construction as the raceway previously described.
This raceway veered in a northwesterly direction and extended from the plenum downward over a wall top plate. It
passed through the top of the pastry display case and into an off-on switch box located in the northwest corner of the


near the northeast corner of the side stand. conduit chase. long. The raceway was inserted into a hole cut or punched (not drilled) into this metal plate (see Diagram K. V-6 I . x 4 in.M. x 4 in. from floor level. Further observation of the raceway showed that it extended down through the interior of the east wall of the side station to a point at which it was attached to a 4 in. Inserted into this receptacle outlet was a male plug which extended into a paragon timer. POINT OF ORIGIN (Continued) pastry display case. At this point of contact.M. Above the refrigeration unit was a tub-like fixture with a lid. but remained in a free position. the copper tube and electrical raceway extended into a 6 in. in particular. x 4 in. where the raceway crossed down and came in contact with a l/2 in. 45 minutes each 24-hour day. In addition. as was any electrical source located in the plenum. It had two copper wires which in turn supplied electrical current for two ceiling or high hat recessed lights in the center ceiling area of the side station. Section VI). the refrigeration unit operated approximately 23 hours. approximately 4 in. conduit was eliminated by the O/Rs as a source of ignition or electrical fault.M. It is the opinion of the O/Rs that the electrical equipment involved from that point of the junction box on the east wall of the side station. west side.T. It did not have as its electrical source any junction in or near the side station. It should be noted that this cellulose material to which the refrigeration unit was affixed was not attached to the shelf itself. thus the bare wires were exposed.M. a warming apparatus was observed on the stainless steel counter top. seven days a week.F. It is believed that this warmer was simply used to warm water for tea or other drinks for the patrons of the restaurant. The O/Rs believe that this switch only controlled a light within the pastry case. It could be freely moved in or out of its location by pulling the unit toward the center of the side stand. hole approximately 6 in. and. that raceway which extended to the refrigeration compressor’s outlet. void of insulation. E.T. and no other electrical sources observed in the ceiling area or plenum could have been a contributing factor to this fire. Two copper wires were exposed. The timer was connected with a pigtail approximately 12 in.T. metal junction box containing a duplex female receptacle. which was actuated for a period of approximately 15 minutes per 24-hour cycle. while the raceway was attached to and terminated at a 4 in. Where the raceway curved over to the top plate. The male plug was attached to an undetermined size electrical cord. under the worktable or counter top. The copper tubing was attached to two fittings in the refrigeration compressor. It is the opinion of the O/Rs that this free standing refrigeration unit could be moved in any direction. the O/Rs observed that the raceway had suffered heavy decomposition to the extent that it had melted and flowed onto the l/2 in. not connected with the raceway. Section VI).T. and that aluminum flexible raceway which extended from that box to another 4 in. More specifically. The second raceway which was attached to the junction box traversed in an easterly direction and turned downward at a sharp angle on the center of the top plate of the east wall. this heat spread occurred only after the initial ground fault occurred in the area near the west side of the splash pan in the soffit adjacent to the west end of the pastry display case. from floor level in the east partition of the passageway entrance to the side stand. This E. This non-refrigerated tub was filled with ice and used to cool those articles normally cooled in a restaurant area. is the only electrical equipment which is a contributing factor to this fire. x 2 in. however. This area was eliminated as an area of origin. the raceway that extended into the pastry display case did assist somewhat in the propagation and application of heat spread. The two visible copper wires were void of insulation. severe decomposition had occurred. junction box that was located approximately 51 in. In the opinion of the O/Rs. causing melted metal to build up and flow. Severe heat application had occurred at this bend. junction box in the plenum overhead center of the side station. from floor level (see Diagram L. E. The E. conduit was a separate electrical source. This refrigeration unit was positioned on a level plane constructed of cellulose material (believed to be particle board) in that area described as the north portion of the side stand. which had a female end into which a male plug had been inserted. The paragon timer was used for the defrost cycle of the refrigeration unit. which in turn was connected to the electrical components of the refrigeration compressor itself. Raceways were followed and traced to great distances. As previously indicated.

v-7 . a contributing factor due to poor location. obtain this unit. However. which the O/Rs could observe due to the decomposition of those combustible materials customarily used to cover wiring. However. Nevada (702) 451-1743. The unit was impounded.5 (amp rating). it is the opinion of the OiRs that the compressor was. that damage may result in failure of the system and ignition of the system itself and/or the building or its contents. Fire Chief. Although several factors contributed to the cause of this fire. V. Captain.. and junction (splice) boxes to which “Utilization Equipment” is connected. They are: 1) ‘Fires originating within the electrical distribution system. At approximately 1300 hours on December 12. as stated above. 1980. of 5216 South Pecos Road. Investigator Porter removed the tag that was attached to the unit and affixed a standard evidence tag issued by the Clark County Fire Department.100 Hz50 PHI. It is the opinion of the O/Rs that the following conditions were responsible for the fire in the MGM Grand Hotel/Casino. Wayne M. V115 H. lighting. was present at Clark County Fire Department Station 18 (located at 707 East Desert Inn Road. and the resultant 85 (as of February 7. representing PM Mechanical.’ 2) ‘Fires originating within the electrical utilization equipment. did in fact initiate this tragedy. and Wm. Burns. It is the opinion of the O/Rs that no ignition occurred in or around the immediate area of the Tecumseh unit. Electrical utilization equipment includes appliance and fixtures attached to the electrical distribution system. which he signed and dated. FIRE CAUSE The following scenario describes the condition of materials and fuel load in and around the immediate area of origin. electrical fires can be divided into two major classifications. The compressor was eliminated as a source of ignition. Las Vegas. Present at the inspection were Roy L. 1980. It should be noted that the order in which the scenario is transcribed does not necessarily reflect the actual sequence of the incipient fire. If the heat developed within the system is allowed to build up to the point where it causes damage to some portion of the electrical system.60. No fire or char patterns were found in that area which would indicate any malfunction of the unit. Nevada) to conduct the examination on behalf of the Clark County Fire Department Fire Investigation Division. Investigator Vergus Porter of the Clark County Fire Department did. in the opinion of the O/Rs. Mr. where it remained in custody of the O/Rs until the testing procedure took place on December 12. Such equipment may be permanently connected (hard-wired) or cord-connected with a plug to a receptacle. Mike Patterson. Jasich. The tag bore the following sequence of numbers and letters: #8327-17 (E-FO773C 710068) CAT #34 #LRA 32. the primary condition was related directly to an electrical fault. Lomprey. nevertheless. the unit was returned to the O/Rs for safekeeping until December 16. 1980. No other electrical sources of heat were observed in the side stand except that wiring normally located in the ceiling and walls. Parrish. 1981) fire deaths. It should be noted that on December 8.- G. which were then transmitted by the copper wires attached to the unit. Lorne L. The electrical distribution system consists of all of the permanently-installed electrical equipment from the point where the power company’s wires first terminate in or on the building (usually at an electric meter) up to and including receptacles. as well as injury to approximately 700 human beings. Las Vegas. Because all practical conductors of electricity exhibit some resistance to the flow of electrical current. Phil Murphy. Captain. Inc.’ The only electrical utilization equipment visible from within the side stand’s confines was a refrigeration compressor unit. at which time it was returned to Mr. switches. Pete Jasich. was identified by the metal identification tag attached to the metal housing of the unit. The unit was transported to Clark County Fire Department Station 18. because of the warm air flow over its condenser and the vibrations created by the operation of the unit. After the test. an electrical. chemical. as a precautionary measure only. “Utilization Equipment” is defined in the National Electrical Code (NEC) (1)’ as: “Equipment which utilizes electrical energy for mechanical. with permission of MGM representative Mr. 1980. at 0800 hours. or similar purposes”. brand name Tecumseh. the descriptions of galvanic action and the heat buildup in the soffit area reflect occurrences which did induce and aid the actual electrical ignition which. heating. - - According to the Fire Investigation Handbook #134 (National Bureau of Standards) 8-80. This compressor. hydraulic and mechanical inspection was made of the compressor unit. the production of heat within an electrical system is an inescapable result. Captain.

P. Tambley Pete Jasich W..Mr. 1980. evidence was again viewed at Clark County Fire Department Station 15 (located at 3480 Valley View Boulevard. Daniels Ed Hanford Tom Alfrey D. Bailey & Broder Bailey & Broder Plaintiffs Committee Waiar. Robins. Jasich A. Martinsen.C. Larson. The unit was in good operating order prior to the fire. Bayless. Mr. Robins. Nevada). interested persons also viewed additional evidence seized by the Clark County Fire Department Investigators.. Zelle. Rolf Jensen & Assoc.L. Armstrong Wendell Gauthier Ira Sternberg Michael Becker S.P. Photographs were taken in chronological order during the inspection by Identification Specialist Nancy Kingsbury. & Kaplan Galatz. Crawford Wiestling Wayne E. Hart. Larson & Kaplan Galatz. nor was there any hydraulic or mechanical fault that caused any malfunction of the unit. Ault Richard A. Murphy disassembled the unit and stated that. Gresham Hall & Evans Galatz.D. in his opinion. Persons in attendance were (note: illegibility of portions of the original registration sheet may have resulted in inadvertent errors or omissions in the following list): EXAMINATION OF REFRIGERATION UNIT PERSONS PRESENT NAME Nancy Kingsbury George M.J.S. Zelle. Zelle.C. there was no electrical fault emitting from the unit. Chesley Robins. In attendance were investigators and attorneys representing the MGM Grand Hotel/Casino. Inc. Lee Bailey (Cal Potter) (illegible). Las Vegas. he is a licensed contractor in the State of Nevada.P. Will Kemp Cal Potter James E. Earl.V. Stewart Farnet John Primrose G. Guesman Carl L. NAME Rex Wilson J. and has in excess of 28 years experience in this field. Under the observation of the O/Rs. who had been unable to attend the viewing held on December 12. Zelle. R. P#llO7.F.T. Architect Galatz. Jr. J. Jasich BKS & M Edwards.M. I. Pearson & Hale V-8 CLIENT Kemper Kemper Kemper MGM MGM Property Damage (Armor) Property Damage (Armor) . Larson & Kaplan Rolf Jensen & Assoc. Duncan Art Rabourn John Shuff B. Schmeider. Inc. Fulfs FIRM L. Biggar Wendell Gauthier Cal Potter F. Schultheis Anthony Shapton Floyd Hale FIRM Firepro Firepro Firepro A. 1980. Drake R. Robins. Murphy is an expert on refrigeration compressors. & B. During this examination. Jon C. Las Vegas Metropolitan Police Department.B. Larson & Kaplan CLIENT N/A Wendell Gauthier Miscellaneous Bailey Bailey __ Kellers Tassen Tassen (illegible) Bailey Velone Wendell Gauthier Tassen Tassen Peter Jones Peter Jones __ MGM Tassen At 1000 hours on December 19.

’ b) ‘Some electrical wires are encased in a metal jacket (type AC armored cable. the utilization equipment. and “neutral” are defined in the NEC since these terms describe wires used in very specific ways in the system.’ 4 ‘ “Hot Conductor (any wire not a “grounding”. both principles “a” and “b” were applied. However. or “neutral” conductor. conduit or tubing) does not carry any current in a properly functioning electrical system. ‘The “grounding” conductor (or metal jacket. “Identified”. the “grounded”. a “grounding” or “grounded/identified/neutral” wire must never be connected through a fuse or circuit breaker. point in the electrical distribution system -. white. The metal armor. The “grounding” conductor carries current only if there is a breakdown of the insulation of the other conductors. The “grounded”.’ v-9 . All such portions are set apart from the text by single quotation marks. This wire is required to have green-colored markings (if it happens to be insulated) or it can be left bare (no insulation). “identified”. only “b” applied.. A hot conductor must always be provided with “overcurrent protection” (a fuse or circuit breaker) where it receives its supply of electricity. The wires are the “grounding” conductor. Except in very special cases. The terms “grounding”. or “grounded/identified/neutral” wire . the bare or green-colored conductor can be eliminated. CLIENT Property Damage (Armor) Property Damage (Armor) Property Damage (Armor) 1. armor. “identified”. The NEC also requires that those conductors given a defined name in the Code be marked but these same conductors cannot have a color which could cause them to be mistaken for the “grounding” and “grounded” conductors. Gresham Co. or “neutral” conductor must always be identified by a white or natural gray color. in the soffit area (point of origin).- - NAME Randy Patton Doug Bennett Robert Lowe Ed Hanford FIRM Edwards. the over-current protective device serving the hot conductor in the circuit should open. shutting off the faulted circuit when the current flows in the “grounding” conductor.This is a safety wire which is intended to carry the current which might escape due to a failure in the insulation of the hot wire (or failure of the insulation within an appliance) back to the source of the current. The “grounding” conductor is intended to eliminate such a potential shock hazard by giving the current an alternate path to return to its supply. “lineside”. not likely to be found in residential construction. In residential construction. Since the “grounding” conductor is intended to be a low resistance path for the current to follow. Hart. under these conditions. or natural gray. or a failure within the utilization equipment which would accidentally energize metal parts of the system. or tubing can serve the same purpose as the “grounding” conductors and. To summarize these Code rules:’ a) ‘“Grounding” Conductor . and one or more hot or unidentified conductors. Pearson & Hale Electrical Engineer Fire Investigator R. or “Neutral Conductor” . GROUND FAULT (IMPEDANCE FAULT) * Portions of the following text are quoted from the Fire Investigation Handbook #134 (National Bureau of Standards) 8-80. ‘Modern residential electrical distribution systems make use of three or more wires to provide power to electrical utilization equipment. “hot”. all other conductors are simply described by common names such as. “identified”.’ c) ‘ “Grounded”. also known as BX cable) or are installed in metal conduit or tubing (rigid conduit or electrical metallic tubing. the hot wire is usually black or red. and since a fault within the system or equipment to ground usually presents a lower resistance path than that through a properly operating appliance.’ In the case of the conductors in the side stand. “grounded”. A hot conductor must always be insulated and may be any color other than green.the point at which the electric cables first enter the building (inside the “service entrance equipment”). type EMT). It can be thought of as the wire which usually returns the current to the supply by completing the circuit after the current has passed through the appliance from the hot wire.L. or the building. and only one.This is a wire which is intentionally connected to the “grounding” wires at one. conduit.This is the wire which can be thought of as supplying the current to the appliance. and so on.

Portions of the raceway were unwound and unconnected. fuses or circuit breakers fail to perform (are defective) or have been defeated (a penny under a fuse). Though fuses and circuit breakers open quickly under short circuit conditions. probably far in excess of the setting of the Overcurrent Protection (fuses or breakers). perform a continuity test on the timer contacts.1. If there is little resistance at the point of the short circuit. there may be some momentary sparking due to the high current flow through poor and/or unintentional connection points in the system. the short circuit current may be just at the rating of the fuses or breakers. v-10 . it is even more likely that the wiring system could become hot enough to cause ignition before the fuse or breaker operates. if any. they cannot open instantaneously. such as the melting of one of the wires or operation of the “main” breaker or fuse. Such sparking may be sufficient to ignite nearby combustibles. or tubing serves as the “grounding” conductor. Occasionally. Through examination of the raceway in and over the side stand. the short circuit current will continue until something else opens the circuit.Rs observed Mr. Arcing was observed where the raceway and E. GROUND FAULT (IMPEDANCE FAULT) (Continued) There are exceptions to these general. In such cases. Box connectors and the flexible raceway did not have a good contact. lighting. National Fire Protection Association. heating. Sometimes the short circuit connection will be poor or the “grounding” path connections will be loose. a metal conduit. It was further noted that the paragon timer had stopped at 1290 midnight. in which case they may take a relatively long time to open.) The O/Rs further observed that the extension of the existing raceway was connected to circuit #24 located in panel #1 x KO in the Barrymore kitchen (according to blueprint #E-257). chase came in contact with each other and where the raceway came in contact with the metal studs. conduit. If the hot conductor contacts a “grounding” conductor (bare or green wire). the current flow within the system will be much higher than “normal”. If the overcurrent protection is set too high for the size of the wiring protected. John Caloggero. In either case.’ It should be noted that information obtained by the O/Rs indicated the raceway in question was added after initial construction was instituted. and so on).’ The metal raceway (tubing) acted as the “grounding” conductor in the side stand. (The O. Or. Under such conditions. and circuit #24 was protected by a 20 ampere circuit breaker. a metal water pipe or the frame of a washing machine. As a consequence. in certain areas. if one is installed. a line-to-neutral short circuit occurs. the metallic sheath of the armor. Poor construction techniques. The O/Rs observed several loose connections between the junction box connectors and the flexible aluminum raceway. a line-to-ground short circuit occurs. and therefore does not reflect the original blueprint or architectural design. The fault will continue until either it clears itself or gets worse and causes an ignition. the results indicated the contacts were in an “on” position. the “grounding” conductor need not be used. summarized code rules. contributed greatly to the electrical conditions observed. in which case they will not open. in the opinion of the O/Rs. one of which states: ‘When the equipment is supplied by an armored cable or by wires in conduit or tubing.T. the armor of a BX cable. ‘A short circuit is an unintentional connection between a hot conductor and either a “grounding” or “grounded” conductor which results in current by-passing the utilization equipment (appliances. it was determined that a ground fault condition did exist prior to the fire.M. Thus there may be enough resistance in the circuit to limit the short circuit current to a value below the rating of the fuses or breakers. If the hot (black or red) conductor contacts the “grounded/identified/neutral” conductor (white or natural gray). This raceway does not appear on the original blueprint. the resulting current flow will be very large.

This arcing produced that amount of heat needed for ignition temperature. The delayed action caused the electrical current to attempt to seek a ground. from floor level in the soffit area.- . there is no question that a ground fault occurred. exposing the bare copper conductors. Electrical fires can occur even when properly operating circuit protection is installed. The lack of proper ground equipment for the conductors to provide a low impedance rate to carry the fault current to trip the breaker allowed a longer period of time for arcing to occur. . This in turn caused the raceway to overheat to the point of glowing metal. Short circuiting occurred in the exposed copper conductors because only two conductors existed (no ground).1. and the ground could not function the way it was intended. GROUND FAULT (IMPEDANCE FAULT) (Continued) In the opinion of the O/Rs. Improper installation and exposure to the warm atmosphere surrounding the raceway caused the insulation surrounding the copper conductors to loosen and deteriorate. when it could not find a ground. This caused additional heat build up in the area approximately 45 in. Installation of the raceway to the junction boxes was faulty. As an example. it caused the copper conductor to become warm and eventually hot. loose connections at termination points can cause this effect.

may cause breakdown of the wires’ insulation. except for that portion which had vaporized.e. details on this contact are put forth in that section below entitled. common practice for workmen to pull wires through E. or metallic flow is indicative of an unintentional electrical path. Pulling the wire over jagged metal.M. v-12 .’ As the heat generated by the fault occurred. As the copper wires would cool. This. etc. in the opinion of the O/Rs. re-heat. and the entire circuit would become energized. In most cases.) and loosen. but simply smashed through by a blunt instrument (leaving sharp. may be the source of the colorful description of “fire racing along the electrical wires”. third paragraph states: _ & m “In summary. a ground fault did occur.W. a combustible material. jagged edges). this small abrasive effect would cause a high impedance over a period of time. electrical clips or other driven fasteners were observed in or through the raceway. but would also pit. The combustible material is cooled to below its ignition temperature. I The pit in the E. (Metal contact was made. b. and an ignition source are essential for combustion. During the course of this investigation. No nails. however. c.T. or metal raceways. type wire with T/W type insulation should not exceed 140°F. if ignited and not concealed. ‘Overheating. It is. for normal operating temperatures. therefore.M. GROUND FAULT (IMPEDANCE FAULT) (Continued) As stated earlier. but arcing and sparking at that point 45 in. would certainly cause a minute stretching effect. expansion and contraction will cause the insulation to deteriorate (i. The National Fire Protection Association Handbook. crack.1. All of the material presented in this handbook for the prevention.G. which is not sufficient to melt the wire or operate the fuses or breakers.T. it is unknown to the O/Rs whether a thermostat was actually installed or was functioning prior to the start of the fire. the O/Rs did observe the raceway in its entirety. Flames are chemically inhibited. Page 6. however. Breaks in the form of “nicks” could have occurred during this pulling process. Chapter 2. the wire was stretched minutely. deterioration would occur. would not only damage the plastic insulation on the wire (conductor). which would induce an unintentional path seeking to complete a circuit. “Galvanic Action”.” 2. 3) Combustion will continue until: a. The combustible material is consumed or removed. or extinguishment of fire is based on these principles. such as those inserts in the metal framing which were not cut by saw. the only way wire can be inserted through a tubular body is by pulling. eventually failing to insulate the conductor.) The National Electric Code states that #14 A. from floor level was occurring. chip. The gases given off by the decomposition of the insulation may be flammable and. open flame appeared. As workmen were pulling the copper wires through the aluminum raceway. At higher temperatures. the science of fire protection rests upon the following principles: 1) An oxidizing agent. The oxidizing agent concentration is lowered to below the concentration necessary to support combustion. control. GALVANIC ACTION NOTE: I I The refrigeration compressor unit normally functions with a thermostat. 2) The combustible material must be heated to its ignition temperature before it will burn. d. Within minutes. chip or scrape the conductor itself. cool and re-heat. not only was the raceway “glowing”.

70 volts.- - - - - 2. these vibrations would. The galvanic action (which was aided by the minute vibrations caused by the normal operation of the refrigeration unit) occurring at that intersection of the raceway and the copper tubing exposed the copper insulated wires. Continual contact between the two metals would cause what is known as “galvanic action”. thereby allowing the aluminum body to become a part of the energized conductor. the vibrations were present for a period of approximately six years. in part: “. v-13 . The area of origin was determined to be the northwest interior corner of the side stand. but several factors were present which contributed to the cause of the fire. Although minute. the O/Rs concluded the aluminum would corrode or dissolve prior to the copper tubing. preheated those common combustibles in and around the soffit area. and that the primary cause was electrical. therefore. which caused a ground fault to occur. The metal higher in the series is gradually dissolved where electrolysis occurs (see table 3-9 B). Improper installation allowed the aluminum body to come in contact with the copper body of the energized conductor.” Table 3-9 B states.. etc. The void thus caused in the raceway would expose the insulation to its immediate atmospheric temperature. hot air generated from the constant air movement over the condenser of the Tecumseh refrigeration unit was blown (forced) into a 2 in. which in turn caused an impedance. These vibrations were transmitted through the copper tubing which was affixed to the unit. are responsible for corrosion of metal piping. in the soffit of the west interior partition. thus lowering their ignition temperatures. cause chafing or scraping of the two metals concerned. Galvanic action may occur between different compounds as well as between metals and even between different parts of the same piece of metal or between different forms of the same metal. at that intersection approximately 45 in. exposing the contents of the raceway (those contents being the two copper electrical wires). Outside air and heat (atmospheric temperature) not common to the interior of the tubular raceway would be allowed to enter through the hole. Whenever dissimilar metals are in contact in the presence of moisture. an effect is produced like an electric battery. As previously indicated.aluminum (AL) carries + 1. hole which was cut into the wall soffit to allow the two copper tubes to penetrate the soffit for return and supply to the pastry cooler. GALVANIC ACTION (Continued) As previously stated. The pulling and. By virtue of its constant operation (excluding the daily 15 minute defrost cycle). x 6 in. or. Hot air flowing over the condenser as a result of the fan blowing across the coils. OPINION OF FIRE CAUSE It is the opinion of the O/Rs that not one. tanks.34 volts.. published by the National Fire Protection Association. over a long period of time. from floor level. 3. below and to the west of the pastry display case. certain vibrations occurred. Where the copper tubing crossed or came in contact with the aluminum raceway. approximately 45 in. The fourteenth edition of the Fire Protection Handbook. The constant motion of the fluid would add credence to the O/Rs’ opinion. including the conductors. and copper (CU) carries -0. their insulation and the surrounding cellulose materials. the refrigeration compressor unit was not permanently secured in its compartment under the counter of the side stand. in general. this created the glowing (hot) effect of the raceway. stretching of copper conductors caused nicks. This additional heat. explains the term as follows (Pages 3-127): “Self-generated electric currents due to galvanic action between different metals in an electrically conducting medium. which was constant except for that 15 minute defrost cycle each 24 hours. from floor level. such as water containing salts. did add to the heat application into that wall soffit and affected those materials in the soffit.” Utilizing the quoted information. The direction of the current depends upon the relative position of the metals in the electromotive series.

When ignition did occur. There was wall-to-wall carpeting with pad. As the wood and other combustible materials began emitting those gases or vapors needed for a fuel substance. and as the gas evolution continued. polyvinyl plastic. The covering on the walls of the Deli consisted of several layers of wall coverings such as veneers and wood paneling. had numerous plastic components. failure to insulate the full length of copper tubing. although mostly constructed of metal. OPINION OF FIRE CAUSE (Continued) There was a time factor fo approximately six years. but in the larger area. and improper installation of the metal raceway to the metal junction boxes. Crap tables.) H. Upon arrival at the combustible body. The slot machines. (For fire and smoke spread. this enabled the ignition temperature to be easily reached. woods. and other related gaming paraphernalia were constructed of wood frames with coverings of plastics and felt. Those products of incomplete combustion and fire were filing the atmosphere in the plenum above the Deli via the 24 in. allowing an aluminum raceway to come in contact with the copper tubing. Inasmuch as the soffit and related areas were constantly preheated. the booths and chairs were covered with polyvinyl type material. As it spread upward and outward from the upper wall of the side stand. and the decorative boxes (which gave the appearance of open beams) which were common throughout the Deli ceiling.3. The total combination of these plastics. and other highly volatile materials which emit large volumes of heat and thick. during which an endothermic condition evolved into an exothermic action. which included plywood and plastic laminated materials. and numerous picture frames embellished the walls. and as the fire progressed it spread upward and outward. see related sections below. which travels at the speed of light. Heat travels in three ways. this surface fire load (which occurred from the ceiling downward) was equally responsible for fire propagation. x 24 in. the application of heat over a period of time. The O/Rs concur that the fire did start and propagate as a result of a ground fault caused by a combination of poor workmanship (electrical wire installation). Assorted wall coverings. According to witnesses. wood. In lieu of money. When ignited from the radiation exposure. those gases did ignite from the arc caused at that defined area of origin. These articles were constructed of wood base. as well as the gypsum wallboard and assorted wood veneer paneling and wall coverings which overlayed the metal stud construction of the walls. It is the opinion of the O/Rs that actual flame was present in the wall soffit area at approximately 0700 hours. FLAME SPREAD Oxygen and heat were present to form the fire triangle and. Twelve inch square acoustical tiles were affixed to the wallboard of the ceiling. the casino used a money exchange system which consisted of plastic type coins. that being the entire area presented by all materials in the soffit and partitions. Other furniture was covered with a buttercup perforated cloth material. not only in that small area. flocked wallpaper. it consumed those preheated combustibles. open flame did appear at approximately 0713 hours. dense concentrations of carbon and other products found in combustion and smoke. v-14 . covered with polyurethane material. It consumed the ornamental decorations which adorned the walls. and perhaps earlier. “21” tables. preheating and consuming those other combustibles in its path and spreading into the ceiling area of the Deli and plenum above. The same articles of furniture and ornamental fixtures were common throughout the casino area. Energy moves through space as a wave. as with any fire. vibrations in the copper tubing. the waves are absorbed into that body. plastic ornamental trim. ceramic tile. air transfer grill in the Deli ceiling. as was the bar. The flames consumed the gypsum wallboard and acoustic tile which covered the ceiling over the booths and main floor of the Deli. it preheated those combustibles with which it came in contact. one of which is radiation. On the floor of the Deli were numerous ornamental and fixed furniture articles. Tables were butcher block type construction with laminated plastic tops. and other common combustibles at floor level constituted and developed flame spread in these areas. this fire sought fuel. igniting them and continuing to propagate throughout the Deli. galvanic action. pyrolysis was occurring at a faster rate.

based on tests conducted by the Los Angeles Fire Department. This constituted a distinct hazard in that it was the means by which fire could be readily transmitted throughout the building endangering all portions and persons therein. following not only the partition void. but the raceway and copper chase as well. This adhesive was placed on all four corners of the 12 in.) An article from “Operation School Burning”. constant flow of preheated air. or that area nearest the west wall of the passageway of that area described as the area of origin (that same area where the 2 in. then suddenly developed a deep (3-foot to 5-foot) flame front that spread with such rapidity (5 to 10 feet per second) that observers fled their posts. Inc. states on page 29: - “Cellulose Fiber Acoustical Tile 14. This condenser was located at the west portion of the unit. Besides the combustibility of the fuel load. see that information supplied by the testing laboratories to which certain sections and pieces of materials were sent for testing per request by the Clark County Fire Department. One of the principles of its operation was to allow the Freon 12 to be cooled in a condenser which was attached to the unit. to 518 in. a void or space was left between the tile and wallboard. The O/Rs learned that the fan which controlled the flow of air over the condenser also pushed air in a westerly direction toward this hole or cut through. United States Fire Administration. Flame propagation was supported. and restricted most of it to the space in and under the counter. the cellulose fiber tile used at the MGM is believed to be the same tile as that described above. The cellulose fiber tile ignited at temperatures from 700 degrees to 800 degress Fahrenheit and the flame progressed with a “wave-like” action for a few minutes. The continuous heat causes moisture loss and a higher susceptibility to ignition and flame spread. v-15 . decomposes material. the refrigeration compressor operated almost constantly. This condenser was located at the west portion of the unit. square tile to a depth ranging from l/4 in. separated by ceiling beams 2 feet in depth. The air flowed continually upward through the soffit space. This heat buildup will continue until either flame (ignition temperature) is introduced. in fact. The physical location of the compressor/condenser limited the freedom of air flow. (Open flame tests were conducted on the tile adhesive by the O/Rs. In order to understand the manner and probability of ignition from low temperature heat sources up to approximately + 800 “F. only the exposure to heat and to ignition temperature have to be determined. at the MGM. and ignition temperature. was trapped in the soffit and partition spaces.S. and Tom Klem. In one demonstration fire (not included in this report because it was not part of this series) the flame spread rapidly over the surface of the cellulose fiber acoustical tile even though the ceiling was broken into bays.) As noted. several factors must be considered. coupled with an ignition source (such as flame. x 6 in. Federal Specification SS-A-118b and commonly known as “slowburning”) resulted in a very rapid fire spread when ignited. or all products of combustion are removed either by consumption or by physical force. etc.- H. This preheated condition. see report by David Demers. the duration of the exposure to the heat application. there is the insulation factor created by the density and depth of the fuel (example: the thickness of the wood).” - NOTE: - Cellulose fiber acoustical tile (classified Class C under U. The fuel being present. FLAME SPREAD (Continued) - Each of the ceiling tiles were affixed to the wallboard by a glue type adhesive. Because no other information is immediately available on typical cellulose material. in particular that hole or cut through in the soffit. When the tile was placed or set to the wallboard ceiling. published by the National Fire Protection Association.) over a sustained period of time can and will propagate flame. the O/Rs offer the above quote as clarification of the flame spread believed to have occurred at the MGM. (For these ignition temperature figures. arc. 5 feet by 5 feet in size. and the insulation factor being not only the combustible materials but a steady. National Fire Protection Association. (For further details on flame spread.. The rapid flame spread characteristic of the tile can be reduced with the application of a fire retardant paint (Underwriters’ Laboratories. The temperatures which were emitted from the condenser ranged from approximately + 120” to + 180”. listed). thick black smoke emitted as a result of this combustion. This heat had to be dissipated into the atmosphere. the oxygen being present. This is a form of oxidation which. and a certain heat buildup occurs which. the material absorbs oxygen rapidly and has a tendency to not only absorb heat (endothermic action) but to then release heat (exothermic action). hole in the soffit was located).) When constant heating is applied.

and hallway which proceeded east to the Jai Alai area. As the fire increased in magnitude. or 23. which include the security offices. wide and 82 ft. as the flame propagated across the ceiling tile consuming the available fuel and oxygen. the fire spread vertically as well as horizontally into the casino. FLAME SPREAD (Continued) An understanding of the above phenomenon reveals another factor contributing to the cause and spread of this fire. it was observed the wall extended upward several inches past the ceiling tile.500 sq. it stopped abruptly at this wall. waiting for an ignition source. it then acted as a blanket (having an oven effect). the wall soffit itself. long (approximately 101. then spread downward to preheat and consume those combustibles in its path. The air space between the ceiling tile and dry wall not only was preheated. No fire spread or propagation entered these offices. and its ignition temperature was reduced. wide by 576 ft. (Note: the Deli ceiling contained approximately 1. adhesive had been placed on each corner of every ceiling tile. to 16 ft.000 pounds of adhesive. The fire then. the Barrymore Room. the entire length and width of the hotel and casino. seeking not only fuel. The entire wall space. act as a barrier. ft. that is. continued not only over the Deli. the adhesive on the ceiling tile was preheated and in turn consumed by the progress of the fire. These units not only controlled the air flow of the Deli. but added oxygen.). the soffit area above the counter top and under the counter top in the area of the refrigeration unit.) As the fire progressed in the casino at ceiling level. the fire progressed in a westerly direction. In that area north of the casino level. The ceiling area of the Deli was approximately 44 ft. but also the Orleans Coffee Shop. Because of the ceramic shield. in height (depending upon actual ceiling height). affecting the fire in the east and south areas of the Deli. As previously indicated. slowing it slightly. The copper insulated wire located inside the exposed raceway was also preheated. high by 176 ft. As the fire progressed in the Deli. The ceiling area of the casino was approximately 15 ft. arcade level. which had a bottle neck effect on the fire’s propagation. Total footage was approximately 1. casino. swept into the casino. with full force. which had been closed during the earlier stages of the fire. any and all combustible materials in and on the general walls or partition areas of the side station (and including that ceiling area of the side stand) became heated to the extent which over the years reduced the ignition temperature to a point low enough to allow the continuous warm atmosphere to preheat them and cause them to remain heated. With virtually all of the fuel load in the Deli being consumed. The ceiling height in this foyer was approximately 9 ft. It did. This is equivalent to over 12 tons of adhesive. The plenum. the wooden enclosure of the pastry display case. into and including the casino area and the entire hotel.000 square feet. The plenum fed into numerous air handling systems.000 square feet.000 ounces. each patch of adhesive weighed a minimum of 1 ounce. A total of 4 ounces of adhesive affixed to each square foot of tile throughout this area would equal 406.. fire breached the wall separating the Deli and the Orleans Coffee Shop via the mini-bar that supplied beverages to each restaurant.300. and contributing greatly to the direction of fire flow.H. The fire then vented through the front doors of the Deli. There were three air units that controlled the air flow over the area of origin. vast amounts of black smoke were emitted. air flow from the decomposed air duct work. certain offices are located. but were opened by an employee when he attempted to extinguish the fire.000 cubic feet of air per minute. Barrymore Room. but also the coffee shop. The fire then spread into the west foyer leading into the casino.375 pounds. it preheated these combustible materials. V-16 . in effect. As the fire spread upward and outward from the walls of the side stand. breaking down slowly as oxidation took place. as well as the air returned from the main floor elevator foyer and eventually the stairwells. The O/Rs concluded that the flame spread was terminated at ceiling level due to the manner in which the ceiling tile was butted up to and against the wall and the fact the fire rated door held. the ceramic tile on the walls first became a reflective shield for open flame. The fire broke through the ceiling area in the plenum above the Deli. although smoke spread was very heavy. the adhesive on ceiling tile. which would equal 4 ounces per tile. but contained normal atmospheric oxygen which supported the combustion process. long. which was nothing more than a gigantic air return measuring approximately 8 ft. At that intersection of the wall and ceiling tile. and combustible materials in the Deli itself. spreading throughout the ceiling area. or approximately 4. each was capable of producing 450. This mini-bar had a door on both the south and north ends to permit ingress and egress of the employees.

simultaneous ignition occurs. Numerous holes in the gypsum wallboard were observed in various places approximately 9 ft. drapery. preheating and consuming the combustible materials in the canopy area (that area where hotel guests are escorted to the main entrance of the casino. which then fell and crushed the elevators. The fire did not actually propagate in the stairwell past this fifth floor opening. 4n interior finish that absorbs heat readily and holds it. flashover is when there is an excessive buildup of heat and gases from the fire itself. smoke. If the finish material is combustible. FLAME SPREAD (Continued) It is the belief of the O/Rs that a phenomenon known as “flashover” occurred at this time. the size and shape of the space in which the fire occurs becomes a critical factor. - Interior finish plays an important role in the occurrence of flashover. If extinguishment had not occurred as promptly as it did. Chapter 6. simultaneous ignition occurs. and fire were drawn into the elevator shafts and the elevators themselves. It was through these construction cutouts that additional heat and smoke spread upward into the plenum and spread throughout the plenum and staircases. page 45. The elevator doors were not tightly sealed. Within 6 minutes of the time of discovery. carpeting. a high rise fire would surely have ensued. heat from the fire spread to those combustible materials in the plenum. and the area becomes fully involved in fire. between the ceiling and fifth floor level reinforced steel/concrete decking (which is an extension of the plenum area). as an insulator would. and portions of the roof over the Deli and Barrymore Room were decomposed. sustained moderate to heavy fire and heat damage. and wall coverings in Rooms 575 and 577 sustained minor fire damage. Because firefighters were in the area of origin extinguishing the fire. Doors to the convention rooms in this area were closed. and a gap of approximately l/2 in. it consumed a protective plywood covering that was constructed at the bottom level of a stairwell (identified as stairwell #W-2) which separated the plenum area above the casino level from the fifth floor landing of the smokeless stairwell. where it extinguished the fire which had extended to those guest rooms. ” - - - - Simply stated.H. Heat. As the fire spread through the casino. at a burning rate (fire spread) of approximately 15 to 19 feet per second. east of the “T” intersection of the building itself. which have been heated by the fire. That area directly above this hallway. consuming common combustibles and extending up the elevator shafts. contributing factors of flashover are: “Flashover is now believed to be caused by thermal radiation feedback from the ceiling and upper walls. the fifth floor level of the hotel high rise begins. which allowed heated gases and fire to enter the elevators and elevator shafts. When all the combustibles in the space have become heated to their ignition temperatures. The fire spread east in the hallway which extends into the Jai Alai area. That area to the north of the Deli. the total casino area was involved in fire. This radiation feedback gradually heats the contents of the fire area. it was stopped and extinguished by activated sprinklers. The fire literally blew out the west doors of the casino. This released the counter weights. The fire extended vertically through an opening in the gravel splash guard on the west side. casino level. Section VI). According to the fourteenth edition of the National Fire Protection Handbook. and where valet parking and luggage control are handled). v-17 . might reduce the time to flashover. The fire consumed the entire ceiling of the Deli. and all combustible materials are heated to their ignition temperature. above the plenum. thus exposing the entire plenum. and no fire extension occurred in these rooms. as there were no combustibles in the smoke proof stairwell. The consumption of this “protective” plywood covering allowed the superheated gases and smoke to travel up this stairwell. and the fire followed. it will also be a source of fuel for the fire. Curtains. The metal cables were heated to such a degree that they weakened and stretched. they were not caused by the fire spread. Considering the nature of thermal radiation. was therefore exposed. this stretching action caused the cables to snap. - The fire also spread horizontally into those hallways which contained the passenger elevators. These holes or voids were man-made. did sustain severe fire decomposition. at roof top level (see Diagram Q. steam from the water application followed those air currents and the path of the fire into and through the roof area. resulting in the fall of two elevators from the main casino level to the basement. to 314 in. above floor level throughout this hallway. Directly over the Deli. at the west end of the high rise.

It is believed that the smoke filled the area above the plenum. in diameter. and virtually everything that was combustible in the Deli. this smoke accumulation was recycling through the plenum. The by-products were flowing toward upper levels through air currents and the exothermic atmosphere created by the smoldering fire. The plenum over the casino had several large A. heat and fire gases from the building. as was the majority of wood grained ornamental molding and trim. It followed pipe chases and open shafts. FLAME SPREAD (Continued) Metal trusses. the oxidation and exothermic processes constantly emitted a slight odor in some form of by-products. this smoke would have been virtually impossible to detect. the heat and pressure build up intensified. which supported that roof area over the Deli and the Barrymore Room sagged. the casino. seeking a place for its warm gases to escape. in particular those pipe chases that were not porperly sealed. therefore. difficult to describe the damage done to this building by the fire. SMOKE SPREAD The smoke spread did not follow or adhere to that path taken by the fire. It should be noted that neither the intersection nor the smoke venting from that area were visible at any point between Station 11 (that station directly across the street from the MGM Grand Hotel. For several hours before the actual sighting of the flame. These. when exposed to heat or flame would in themselves produce products of combustion. Usually. from which the first-in company responded). adding to the fuel and smoke level. video tapes and photographs of the affected areas effectively convey the magnitude of this fire’s destruction. (Acrylonitrile-Butadiene-Styrene) plastic pipes which were used for rain drainage from the casino’s flat roof. two of which were 12 in. The smoke had been slowly building for quite some time in the area of origin (see Diagram D. they rise. and the surrounding area was consumed by the progress of this fire. It is believed that the smoke filled every conceivable space and rose upward at every opportunity.H. it is this mass that actually produces a pressure buildup and causes those hot gases to flow outward progressively. As the combustion process continued. in so doing they entrain cold air. elevator lobbies. I. Natural air movement in any building. Weather conditions for November 21. which then becomes heated and contaminated. These lateral pipes. and the point of arrival of the first-in company. the wind was calm and had no direct effect on the ventilation of the MGM. bowed and twisted from the heat of the fire. it is also influenced by weather conditions. which is a planned systematic removal of smoke. It is difficult to state exactly where the smoke traveled first and to what degree. but followed that path or avenue of air currents of least resistance. Las Vegas. it began to spread horizontally. 1980. “Crystal” chandeliers were not crystal. is an important fire department function. upon their initial arrival. I Since the hot combustion products from a fire are less dense than the surrounding air. As the smoke filled the area above the plenum. Nevada. It is estimated by the O/Rs that an abundance of electrical wires were in this area. were: (Continued on following page) V-18 1 I . which was located in the center ceiling of the side stand. unknown to them. Copper wire insulated with plastic coating would also contribute to the fire load and generation of toxic gases.B. and open shafts that were cut through with access holes. smoke was already venting from the southeast intersection of the “T” at the 24th floor area. it began to spread horizontally. but it did enter those spaces in the seismic joints at the “T” of the hotel’s construction on the east side as well as the west side. These byproducts were entering the atmosphere of the plenum through the wall void. some distance from the fire. especially when on fire. which would allow it to penetrate into small and large areas equally. as posted at McCarran International Airport. The fire department. the Orleans Coffee Shop.S. gradually building in volume and pressure. It is. seeking a place for its warm gases to escape. north entrance. did not have any idea of the magnitude of the smoke problem. and eventually through the air return duct in the plenum. This intersection was completely hidden from view of the first-in engine company. The flooring in that area had a camber of at least 18 inches. shape and natural draft conditions. However. but plastic. Section VI). Throughout years of exposure to slow heat. due to the immense size of the plenum. and those deodorants used in houeskeeping practices. Fortunately. It involves providing openings through roofs and walls to permit the escape of heat and smoke. is restricted by size. the numerous air handling units. When they arrived. - Ventilating a fire. exceeding hundreds of miles.

as well as the casino level. Black carbon deposits were visible in several of the rooms at the fixture locations. as in this fire. As that flow of hot gases continues. and can render the human senses useless in an unbelievably short time. and as a result continue to rise. expanding throughout the building.1 or 0. SMOKE SPREAD (Continued) - - Time Temp. the displaced gases do not have an opportunity to cool. formaldehyde. Deposits of these hydrocarbons will adhere to surfaces or drift and filter downward like falling volcanic ash. temperatures exceeding + 2.OOO”F. Particles of carbon (referred to as hydrocarbons by the O/Rs) develop from the decomposition of these tars. Certainly. thereby blocking visibility of exits and exit signs. pulls the smoke and gases upward. By opening the stairwells. While the heat and toxic qualities of fire gases can be injurious or fatal. These gases are usually evolved from the combustible with sufficient velocity to carry with them droplets of flammable tars which appear as smoke. Evidence of this effect was the tremendous volume of smoke and gases which entered the stairwells and elevators. which. The filters in the air handling units which adjoin in the plenum area over the casino were heavily impregnated with hydrocarbons.2 inches of water. the effect of the expansion does not dissipate.800 “F were very probable. They can obscure the passage of light. In this particular fire.- I. large) particles of condensed vapor. Fire gases from common combustibles contain numerous elements known to man. it would have sounded as though the entire hotel was being consumed by fire. some of the guests left their rooms fearing for their lives. (It should be noted that. such as water vapor. carbon monoxide. v-19 . in effect. Even though the displaced gases eventually cool to the ambient temperature. Those stairwells in the center portion of the building. The smoke entered wall spaces indiscriminately. adding to the smoke spread. (“F) 0700 0800 0900 1000 1100 38 42 52 56 58 61 62 64 64 63 1200 1300 1400 1500 1600 Wind Direction w/s/w NS __ NE E SE __ NE NW Wind (Knots) 6 5 calm calm 5 5 5 calm 5 5 During a fire in a confined space or building. During a fully developed room fire. piles of this black mass were visible on the floor where they had fallen from the filters. sustained an unusually heavy amount of deposits of this hydrocarbon material. Smoke is matter. carbon dioxide. to the guest who would have been listening to news broadcasts of the progress of the fire. A “stack” effect is characterized by a strong draft from the ground floor to the roof of tall buildings. formic and acetic acids. When portions (at random) of these filters were removed for evidence and photographed by the O/Rs. the solid and liquid particles in suspension in the gases also have harmful effects. as was evidenced in the fixture pipes that protruded into the shower stalls of the guests’ rooms. Evidence of this was quite clear throughout several of the rooms in the high rise area. Filters in the rooms nearest the center “T” portion of the building were saturated. the pressure may rise by as much as 0. methanol. in particular. methane. smoke was further pulled into the hallways. the atmosphere in the room builds up pressure as the temperature increases. consisting of very fine (and in some instances. The temperature in a room fire with ordinary combustibles will reach as high as +2. guests of the hotel became alarmed by its odor and pressure. As the smoke rose upward.) Some individuals left their rooms to attempt to exit into either the stairwells or elevators.

F. J.S. ventilation and air conditioning (HVAC) units did not function properly.A. other contributing factors were galvanic action caused by the chafing or scraping of the two metals when the aluminum raceway continuously came in contact with the copper tubing. CONCLUSION It is the conclusion of the O/Rs that the fire at the MGM Grand Hotel/Casino which claimed the lives of 85 persons and injured more than 700.000. and those contributing factors of the ground fault itself. failure to insulate the copper tubing. flames propagated into the cars themselves. wall coverings. in fact. thus allowing the heated gases and smoke to continue to spread throughout the entire plenum and building. bolted in such a manner as to make them inoperable. Their failure allowed the counter weights to fall and crush the cars. originated in the wall soffit of the side stand in the Deli. None of the physical evidence examined or impounded by the O/Rs was tampered with. When the fusible links activated (as they should at their preset heat capacity). In the professional opinion of the O/Rs. vibrations of the tubing due to improper installation of the compressor. Fire spread through the casino at 15 to 19 ft. Dampers in the main unit over the casino were. for testing purposes which obviously would be altered during testing procedures. the constant preheating of flammable material. Captain Fire Investigation Division Clark County Fire Department v-20 ’/ . excluding that evidence which was sent to N. furniture and those common combustibles located throughout the area. Captair? Fire Investigation Division Clark Countysre Department Date Fire Investigation Division Clark County Fire Department Date Wayne B@. The adhesive utilized to affix the acoustic ceiling tile. An example of the smoke pressure that was definitely present and contributed to the large loss of life and the number of injuries was seen when the main doors at the west entrance of the building were literally blown outwards into the parking area under the canopy. poor connections of the metal junction boxes to the raceway. Smoke spread via the plenum. as well as the polyurethane materials and polyvinyl products. The primary source of ignition was an electrical ground fault. per second due to a “flashover” involving plastic ornamental fixtures. stairwells and elevator shafts. FLAME SPREAD (Continued) Contributing greatly to this problem was the fact that numerous smoke dampers in the air handling ducts of the heating. and the tile itself. as well as through the HVAC units and seismic joints. the dampers did not close properly. causing the steel cables to stretch and finally fail. Mike Patterson. and U. all findings put forth in this report are true and accurate. which occurred over the years as warm air was forced into the soffit cavity. Elevators fell when their doors opened at the casino level and they were exposed to rapid flame buildup.I. were contributing factors to the dense volume of smoke.B.000. and caused damage that will probably exceed $30. Date Wm. changed or altered in any way.S.


with seating arrangement. north wall. They depict the area of origin.- SECTION VI DIAGRAMS Included in this section are those diagrams and drawings presented by the members of the Fire Investigation Task Force. with approximate measurements. Drawing P The ceiling of the Deli. Drawing G A cutaway drawing of the north wall of side stand #2 in the Deli. looking in an easterly direction. Drawing D Deli floor plan. Drawing B Casino and showrooms floor plan. These sketches are not drawn to scale. and the MGM Grand Hotel/Casino in general. and ceiling area in side stand #2 in the Deli. Drawing N Top and bottom views of pastry display case in north wall of side stand #2 in the Deli. looking in a southerly direction. Drawing M Front and back views of pastry display case in north wall of side stand #2 in the Deli. Drawing Q Typical floor plan of floors 5 through 22 in the high rise of the MGM Grand Hotel/Casino. point of origin. Drawing J The northwall of side stand #2 in the Deli. Nevada. Drawing C Restaurants and meeting rooms floor plan. Drawing F North wall from inside side stand #2 in the Deli. Fire Scene Examination. Drawing H A top view of side stand #2 in the Deli. all measurements are approximate. looking down in a southwesterly direction. Drawing E Detail showing tubing and raceway between cupboard and west partition in side stand #2 in the Deli. Las Vegas. showing the approximate layout of the false beams. VI-1 . - - Drawing A Deli floor plan. Drawing L The east wall. NOTE: There are no drawings designated “I” or “0” in order to lessen the possibility of confusion with the Roman Numeral I (one) and the number 0 (zero). Drawing K The east wall of side stand #2 in the Deli. looking in a westerly direction. The diagrams should be used as reference points and for placement of items and areas described in Section V.

- - - -_ - - VI-3 .

- 2 VI-4 Ll .c .